The Implementation Specialist – Project Manager is responsible for leading the end-to-end implementation of new payer clients and managing ongoing program enhancements for existing accounts. This role is essential to ensuring a smooth onboarding experience and long-term client satisfaction across government-sponsored health insurance programs—including Medicare Advantage, Medicaid, Risk Adjustment, and STARS/Quality initiatives. The ideal candidate brings deep healthcare domain expertise, strong technical acumen, and excels at cross-functional coordination in a fast-paced environment.

·       Develop and manage detailed project plans for new client implementations and expansions.

·       Align deliverables with contractual requirements, internal capabilities, and client expectations.

·       Proactively manage project timelines, risks, and dependencies to ensure on-time, high-quality delivery.

·       Serve as the primary point of contact for all implementation activities, bridging internal teams (e.g., data, engineering, clinical ops) and external payer clients.

·       Lead project meetings, document outcomes, and ensure timely execution of action items.

·       Ensure stakeholders are aligned and well-informed throughout each phase of the project.

·       Respond to client requests for updates related to workflows, data files, and program configurations.

·       Coordinate operational changes for Line of Business (LOB) expansions, benefit year transitions, or program logic updates.

·       Ensure minimal disruption to ongoing programs during upgrades or changes in scope.

·       Oversee the intake, validation, and deployment of client data files related to eligibility, claims, encounters, and supplemental data.

·       Work closely with technical and analytics teams to ensure file formats, schema changes, and ingestion processes meet requirements.

·       Validate system readiness prior to go-live to ensure successful launch and long-term scalability.

·       Manage and document all change requests across assigned clients.

·       Ensure modifications to system workflows, data logic, or configuration are communicated, approved, and properly implemented.

·       Support ongoing improvements by applying lessons learned from previous implementations.

·       10+ years of experience in project management, implementation, or customer success roles within healthcare or health technology.

·       Strong understanding of government-sponsored health plans (e.g., Medicare Advantage, Medicaid) with specific experience in Risk Adjustment and STARS/Quality programs.

·       Exceptional organizational and communication skills with a track record of managing multiple priorities and timelines.

·       Technically proficient; able to work closely with engineering and data teams on file exchanges, ingestion workflows, and validation processes.

·       Proficient in project management tools such as Smartsheet, JIRA, or similar platforms.

·       PMP certification or other formal project management training.

·       Experience working with payer organizations on implementations involving eligibility, claims, encounter, or quality data.

·       Familiarity with healthcare data standards and regulatory programs (e.g., CMS guidelines, NCQA, HEDIS, 837/834 file formats).

 

·       Remote work environment

·       Medical, dental and vision benefits within 30 days of hire 

·       Paid vacation and holidays

·       A fun team and special culture